Provider Demographics
NPI:1689004996
Name:KAZI, MANSOOR AHMED (NP-C)
Entity Type:Individual
Prefix:
First Name:MANSOOR
Middle Name:AHMED
Last Name:KAZI
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 DIVIDEND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8314
Mailing Address - Country:US
Mailing Address - Phone:972-900-0207
Mailing Address - Fax:877-512-6442
Practice Address - Street 1:275 W CAMPBELL RD STE 325
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:877-512-5442
Practice Address - Fax:877-512-7442
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX750481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily